Liver volumetric and anatomic assessment in living donor liver transplantation: The role of modern imaging and artificial intelligence

Abstract

The shortage of deceased donor organs has prompted the development of alternative liver grafts for transplantation. Living-donor liver transplantation (LDLT) has emerged as a viable option, expanding the donor pool and enabling timely transplantation with favorable graft function and improved long-term outcomes. An accurate evaluation of the donor liver’s volumetry (LV) and anatomical study is crucial to ensure adequate future liver remnant, graft volume and precise liver resection. Thus, ensuring donor safety and an appropriate graft-to-recipient weight ratio. Manual LV (MLV) using computed tomography has traditionally been considered the gold standard for assessing liver volume. However, the method has been limited by cost, subjectivity, and variability. Automated LV techniques employing advanced segmentation algorithms offer improved reproducibility, reduced variability, and enhanced efficiency compared to manual measurements. However, the accuracy of automated LV requires further investigation. The study provides a comprehensive review of traditional and emerging LV methods, including semi-automated image processing, automated LV techniques, and machine learning-based approaches. Additionally, the study discusses the respective strengths and weaknesses of each of the aforementioned techniques. The use of artificial intelligence (AI) technologies, including machine learning and deep learning, is expected to become a routine part of surgical planning in the near future. The implementation of AI is expected to enable faster and more accurate image study interpretations, improve workflow efficiency, and enhance the safety, speed, and cost-effectiveness of the procedures. Accurate preoperative assessment of the liver plays a crucial role in ensuring safe donor selection and improved outcomes in LDLT. MLV has inherent limitations that have led to the adoption of semi-automated and automated software solutions. Moreover, AI has tremendous potential for LV and segmentation; however, its widespread use is hindered by cost and availability. Therefore, the integration of multiple specialties is necessary to embrace technology and explore its possibilities, ranging from patient counseling to intraoperative decision-making through automation and AI.

Keywords: Liver transplantation; Living-donor; Diagnostic imaging; Artificial intelligence; Machine learning; Deep learning

Core Tip: Accurate liver’s volumetry (LV) is imperative for successful living-donor liver transplantation to ensure adequate future liver remnant and graft volumes. Manual computed tomography scan delineation conventionally serves as the standard approach; however, it is constrained by factors such as cost, subjectivity, and variability. In contrast, automated LV techniques utilizing advanced segmentation algorithms present superior reproducibility, reduced variability, and enhanced efficiency compared with manual measurements. However, the accuracy of automated LV requires further investigation. The study comprehensively reviewed both traditional and emerging LV methods, including semi-automated image processing, automated LV techniques, and machine learning-based approaches, while analyzing their respective strengths and weaknesses.